Healthcare Provider Details

I. General information

NPI: 1891259420
Provider Name (Legal Business Name): SOHEAB UGRADAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 WOODLAKE AVE STE 190
WEST HILLS CA
91307-1492
US

IV. Provider business mailing address

7320 WOODLAKE AVE STE 190
WEST HILLS CA
91307-1492
US

V. Phone/Fax

Practice location:
  • Phone: 818-936-5070
  • Fax: 818-936-5071
Mailing address:
  • Phone: 818-936-5070
  • Fax: 818-936-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number186849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: